Analysis Of The Effect Factors On Rheumatoid Arthritis With Interstitial Lung Disease

Objective To study the effect factors on rheumatoid arthritis with interstitial lung disease(RA-ILD)by retrospective analysis of clinical data.Methods Basic on the criteria of the 2010 Rheumatoid arthritis classification criteria established by ACR/EULAR,we collected the basic data from the RA patients,who were hospitalized in the Inpatient Department of Rheumatology and Immunology of Peking University Shenzhen Hospital from January 2015 to July 2020 were collected.Data including basic information,clinical manifestations,as well as auxiliary examinations were further analyzed using SPSS Statistical software.Results (1)There were 737 RA patients meeting the inclusion criteria,of which the male to female ratio was 1:4.12.The average age was 49.64±14.00 years.The average course of disease was 4.0(1.0,10.0)years.Among the 737 RA patients,282cases(38.26%)developed ILD,The median time from the onset of the first RA-related clinical symptoms to the onset of ILD was 13 years(95%CI 11.33-14.67).The 5-year cumulative incidence rate of ILD in RA patients was 22.70%±1.80%and the 10-year cumulative incidence rate was 45.40%±2.60%.(2)Multivariate logistic regression analysis showed that advanced age(OR 1.064,95%CI 1.049-1.079,p=0.000),male(OR 1.72,95%CI 1.154-2.565,p=0.008),smoking(OR 2.365,95%CI1.397-4.004,p=0.001),long disease course(OR 1.096,95%CI 1.066-1.128,p=0.000),high DAS28-ESR(OR 1.271,95%CI 1.021-1.583,p=0.032),anti-CCP antibody increased more than 3 times(OR 1.524,95%CI 1.022-2.273,p=0.035),KL-6>300U/m L(OR 2.570,95%CI 1.093-6.041,p=0.030),high LDL-C(OR 1.452,95%CI 1.099-1.918,p=0.009)and elevated CA153(OR 1.276,95%CI 1.070-1.522,p=0.007)might be independent risk factors for RA-ILD,whereas HDL-C was a protective factor for RA-ILD(OR 0.056,95%CI 0.025-0.125,p=0.000).(3)Among the 737 RA patients,298 cases(40.43%)had dyslipidemia,of which 243 cases had low HDL-C and 47 cases had high LDL-C.RA patients with high LDL-C had higher incidence of ILD(57.45%vs.36.96%,p=0.000)and arteriosclerosis(48.94%vs.21.16%,p=0.039)than that of patients with normal LDL-C.RA patients with low HDL-C had higher incidence of ILD(47.33%vs.33.81%,p=0.000)and coronary artery disease(2.88%vs.0.20%,p=0.001)than that of patients with normal HDL-C.(4)The median time of ILD in RA patients with low HDL-C was significantly shorter than that of patients with normal HDL-C[10.0(95%CI 9.33-10.67)years vs.17.0(95%CI 14.58-19.42)years,p=0.000].(5)By stratified analysis,we found the LDL-C level of female and non-smoking RA-ILD patients were higher than that of RA-n ILD patients,respectively(3.01±0.74 mmol/L vs.2.71±0.72 mmol/L,p=0.000;3.00±0.75mmol/L vs.2.73±0.71 mmol/L,p=0.000,respectively),while the HDL-C level of the RA-ILD patients was lower than the RA-n ILD patients whichsoever smoking and gender.(6)LDL-C level was positively correlated with KL-6,and the correlation was stronger in RA-ILD patients(R~2=0.312,p=0.004).HDL-C level was negatively correlated with DAS28-ESR and hs-CRP,and the correlation was stronger in RA-ILD patients(R~2=-0.451,-0.247,respectively,p<0.05).(7)The list of HRCT findings in the patients with RA-ILD were ranked as UIP(56.03%),NSIP(30.85%),OP(7.09%),DIP(3.55%)and LIP(2.48%).RA-ILD patients with low HDL-C had higher percentage of UIP(60.00%vs.53.29%,p=0.002).(8)RA-ILD patients with high LDL-C had higher incidence rate of decrease in forced vital capacity(FVC)than that of patients with normal LDL-C(50.00%vs.21.52%,p=0.015).RA-ILD patients with low HDL-C had had higher incidence rate of decrease in FVC(26.92%vs.16.18%,p=0.003)and carbon monoxide diffusion(DLCO)(80.76%vs.50.00%,p=0.010)than that of patients with normal HDL-C.Conclusions (1)The clinical independent risk factors related to RA-ILD included male,advanced age,smoking,high disease activity,elevated anti-CCP antibody titer,elevated KL-6,elevated CA153,and elevated LDL-C,while elevated HDL-C was a protective factor for RA-ILD.(2)The median time of ILD in RA patients with low HDL-C was significantly shorter than that of normal HDL-C.(3)HDL-C level was negatively correlated with disease activity.(4)RA-ILD patients with low HDL-C were more likely to show UIP in HRCT.(5)RA-ILD patients with high LDL-C were more likely to have FVC decline.RA-ILD patients with low HDL-C were prone to decrease in FVC and DLCO.